Behavioral Interventions to Reduce Inappropriate Antibiotic Prescribing: A Randomized Pilot Trial

Jason Doctor, Daniella Meeker, and colleagues tested three information technology-enabled behavioral interventions to reduce inappropriate antibiotic prescribing for acute respiratory infections (ARIs) in a randomized controlled pilot test trial. Such interventions, known as “nudges,” have been shown to change behavior without the threat of punishment. Over the 18 months of the study, two of the interventions studied collectively prevented on average of one inappropriate prescription for every eight patients seen. The most successful intervention was “accountable justification.” While entering information in a patient’s electronic chart, a prompt would appear, asking the clinician to justify the antibiotic prescription. The written justification would be added to the chart, unless the clinician cancelled the prescription. This resulted in an 18 percentage point reduction, from 23 percent to 5 percent, of antibiotic prescription rates for acute respiratory infections. Overall, the nudges that appealed to doctors’ competitive spirits and desire to strengthen their reputations were most motivating to significantly reduce unnecessary antibiotic prescriptions.

The full study is available at BMC Infectious Diseases. A press release for the study is available here.

Citation: Persell, S. D., Doctor, J. N., Friedberg, M. W., Meeker, D., Friesema, E., Cooper, A., … & Linder, J. A. (2016). Behavioral Interventions to Reduce Inappropriate Antibiotic Prescribing: A Randomized Pilot Trial. BMC Infectious Diseases.